0071643192.pdf

■ May be used to treat refractory tachydysrhythmias by overdrive pacing
■ May be preferable to transvenous pacing in patients who have received
thrombolytic agents

CONTRAINDICATIONS

■ In conscious patients with hemodynamically stable bradycardias, transcu-
taneous pacing is unnecessary.

TECHNIQUE

■ The anterior electrode is placed at the point of maximal impulse on the
left chest wall. The second electrode is placed directly posterior to the
anterior electrode.
■ Set the rate to 60–70 bpm. Then slowly increase the output current from
the minimal setting until capture is achieved on ECG monitor, usually
42–60 mA.

COMPLICATIONS

■ Dysrhythmia induction
■ Soft tissue discomfort with the potential for injury

INTERPRETATION OFRESULTS

■ Feel for a pulse and check BP to confirm that the electrical capture seen
on the monitor results in improved perfusion.

Transvenous Cardiac Pacing

INDICATIONS

■ Bradycardias: Sick sinus syndrome, second- and third-degree heart block,
atrial fibrillation with symptomatic slow ventricular response, pacemaker
malfunction
■ Tachycardias: Supraventricular dysrhythmias, ventricular dysrhythmias

CONTRAINDICATIONS

■ Bradycardic, hypothermic patients should be rewarmed first, then paced if
condition does not improve.

TECHNIQUE

■ Pacemakers can be placed through brachial, subclavian, femoral, or inter-
nal jugular veins.
■ Patient should be connected to an ECG machine and pacemaker to
record chest V lead. The distal terminal of pacing catheter (negative or “–”
lead) must be connected to the V lead of the ECG machine to be used as
an intracardiac exploring electrode
■ Introducer sheath is passed over the guidewire, then pacing wire is inserted
about 10–12 cm into selected vein. If a balloon-tipped catheter is used, the
balloon is inflated after the catheter enters the SVC.
■ Lidocaine may be needed to desensitize the myocardium from catheter
induced ectopy.
■ The ECG recorded from the electrode tip localizes the position of the tip
of the pacing electrode. The ECG complex varies depending on which
chamber is entered, with negative forces seen when the catheter tip is
above the atrium and diminished amplitude seen if the catheter tip enters
the IVC or the pulmonary artery.

PROCEDURES AND SKILLS

When pacing, always confirm

electrical capture seen on the

monitor by palpating a pulse.

Electrical capture without a

pulse equals PEA.

When a magnet is placed over

a permanent pacemaker, the

pacemaker will temporarily

revert to an asynchronous,

fixed-rated pacing usually at a

rate of 60 bpm.

With transcutaneous pacing,

increase to 40 to 60 mA to get

capture. With transvenous

pacing, get capture at 5 mA,

then decrease the amps. Once

you lose capture, increase by

2.5 times to ensure consistent

capture.